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Oregon Department of Transportation RELOCATION <br />FIXED PAYMENT ELIGIBILITY APPLICATION AND CLAIM <br />Nams of tNsplaesd Orgmizatlon <br />VIEW Design, Inc. <br />MatlingAddree' 445 Willamette St. <br />Eugene, OR 97401 <br />°""1Bf~ Jason Halstead <br />TelepFwne Number. ~ 541) 342-3343 <br />(~ Business ^ Farm ^ Non-Profit <br />File No <br />Name <br />Section <br />Highway <br />corny <br />FAP No <br />I hereby apply for eligibility determination for a fixed payment in lieu of reimbursement for all other moving <br />and related costs and expenses. In accordance with ORS 281.070 I have attached state income tax <br />returns for confidential use for audit to determine the payment authorized. <br />®I am the owner of the above business, farm operation, or non-profit organization and that this <br />business, farm, or non-profit organization is lawfully located on the real property from which my personal <br />property will be required to be moved. This business ,farm, ornon-profit organization has been in <br />continuous operation since 1993 <br />BUSINESS <br />® This business cannot be relocated without a substantial loss of its existing patronage. (A business is <br />assumed to meet this test unless the Agency determines that it will not suffer a substantial loss of its <br />existing patronage). <br />® This business is not part of a commercial enterprise having more than three other entities which are <br />not being acquired by the agency, and which are under the same ownership and engaged in the same or <br />similar business activities. <br />® This business had annual gross receipts of at least $5,000 or had average annual earnings of at least <br />$1,000; or contributed at least one third of the operator's average annual net income from all sources, <br />during the two taxable years prior to displacement. <br />® The business is not operated at a displacement dwelling or site solely for the purpose of renting such <br />dwelling or site to others. <br />FARM OPERATION <br />^ The acquisition of the land or part of the land resulted in the displacement of the farm operation, or <br />^ The acquisition caused a substantial change in the nature of the farm operation. <br />NON-PROFIT ORGANIZATION <br />^ The organization cannot be relocated without a substantial loss of existing patronage -membership or <br />clientele. (A nonprofit organization is assumed to meet this test, unless the Agency demonstrates <br />otherwise). <br />To the best of my knowledge, this applicant meets the criteria necessary to qualify for the fixed payment in <br />the amount of $ <br />734-3603 (11/00) <br />